Demographic and health surveys: a profile CORSI, Daniel J; NEUMAN, Melissa; FINLAY, Jocelyn E ...
International journal of epidemiology,
12/2012, Letnik:
41, Številka:
6
Journal Article
Recenzirano
Odprti dostop
Demographic and Health Surveys (DHS) are comparable nationally representative household surveys that have been conducted in more than 85 countries worldwide since 1984. The DHS were initially ...designed to expand on demographic, fertility and family planning data collected in the World Fertility Surveys and Contraceptive Prevalence Surveys, and continue to provide an important resource for the monitoring of vital statistics and population health indicators in low- and middle-income countries. The DHS collect a wide range of objective and self-reported data with a strong focus on indicators of fertility, reproductive health, maternal and child health, mortality, nutrition and self-reported health behaviours among adults. Key advantages of the DHS include high response rates, national coverage, high quality interviewer training, standardized data collection procedures across countries and consistent content over time, allowing comparability across populations cross-sectionally and over time. Data from DHS facilitate epidemiological research focused on monitoring of prevalence, trends and inequalities. A variety of robust observational data analysis methods have been used, including cross-sectional designs, repeated cross-sectional designs, spatial and multilevel analyses, intra-household designs and cross-comparative analyses. In this profile, we present an overview of the DHS along with an introduction to the potential scope for these data in contributing to the field of micro- and macro-epidemiology. DHS datasets are available for researchers through MEASURE DHS at www.measuredhs.com.
Nearly 40% of the world's stunted children live in India and the prevalence of undernutrition has been persistently high in recent decades. Given numerous available interventions for reducing ...undernutrition in children, it is not clear of the relative importance of each within a multifactorial framework. We assess the simultaneous contribution of 15 known risk factors for child chronic undernutrition in India. Data are from the 3rd Indian National Family Health Survey (NFHS-3), a nationally representative cross-sectional survey undertaken in 2005–2006. The study population consisted of children aged 6–59 months n = 26,842 (stunting/low height-for-age), n = 27,483 (underweight/low weight-for-age). Risk factors examined for their association with undernutrition were: vitamin A supplementation, vaccination, use of iodized salt, household air quality, improved sanitary facilities, safe disposal of stools, improved drinking water, prevalence of infectious disease, initiation of breastfeeding, dietary diversity, age at marriage, maternal BMI, height, education, and household wealth. Age/sex-adjusted and multivariable adjusted effect sizes (odds ratios) were calculated for risk factors along with Population Attributable Risks (PAR) and Fractions (PAF) using logistic regression. In the mutually adjusted models, the five most important predictors of childhood stunting/underweight were short maternal stature, mother having no education, households in lowest wealth quintile, poor dietary diversity, and maternal underweight. These five factors had a combined PAR of 67.2% (95% CI: 63.3–70.7) and 69.7% (95% CI: 66.3–72.8) for stunting and underweight, respectively. The remaining factors were associated with a combined PAR of 11.7% (95% CI: 6.0–17.4) and 15.1% (95% CI: 8.9–21.3) for stunting and underweight, respectively. Implementing strategies focused on broader progress on social circumstances and infrastructural domains as well as investments in nutrition specific programs to promote dietary adequacy and diversity are required to ensure a long term trajectory of optimal child growth and development in India.
•Research on risk factors for child undernutrition has been single-factorial and downstream.•We assessed the relative and joint contribution of multiple factors for growth and development.•Maternal stature, education, household wealth, dietary diversity, and maternal BMI were the top 5 risk factors.•Together these five 5 factors accounted for more than 65% of the PAR for child undernutrition.•Strategies focused on social circumstances and direct investments in nutrition specific-programs are required.
Cannabis use in pregnancy has increased
, and many women continue to use it throughout pregnancy
. With the legalization of recreational cannabis in many jurisdictions, there is concern about ...potentially adverse childhood outcomes related to prenatal exposure
. Using the provincial birth registry containing information on cannabis use during pregnancy, we perform a retrospective analysis of all live births in Ontario, Canada, between 1 April 2007 and 31 March 2012. We link pregnancy and birth data to provincial health administrative databases to ascertain child neurodevelopmental outcomes. We use matching techniques to control for confounding and Cox proportional hazards regression models to examine associations between prenatal cannabis use and child neurodevelopment. We find an association between maternal cannabis use in pregnancy and the incidence of autism spectrum disorder in the offspring. The incidence of autism spectrum disorder diagnosis was 4.00 per 1,000 person-years among children with exposure compared to 2.42 among unexposed children, and the fully adjusted hazard ratio was 1.51 (95% confidence interval: 1.17-1.96) in the matched cohort. The incidence of intellectual disability and learning disorders was higher among offspring of mothers who use cannabis in pregnancy, although less statistically robust. We emphasize a cautious interpretation of these findings given the likelihood of residual confounding.
Introduction
Les premiers répondants comme les autres membres du personnel de sécurité publique (travailleurs correctionnels, pompiers, ambulanciers paramédicaux, policiers, agents des communications ...en sécurité publique, etc.) sont souvent exposés à des événements potentiellement traumatisants sur le plan psychologique. Ces expositions sont susceptibles de contribuer à des problèmes de santé mentale et à un besoin accru en soins de santé mentale. Pourtant, aucune étude qualitative structurée et fondée théoriquement sur les obstacles aux comportements de recherche d’aide et sur les facteurs facilitant ces comportements n’a encore été entreprise auprès de cette population. Cette étude repose sur le cadre Theoretical Domains Framework (TDF) pour cerner et mieux comprendre les principaux obstacles et facteurs facilitants relatifs à la recherche d’aide et à l’accès aux soins de santé mentale dans le cadre d’une clinique de traitement des blessures de stress opérationnel pour premiers répondants.
Méthodologie
Nous avons mené des entretiens semi-structurés en personne avec 24 premiers répondants (11 pompiers, 5 ambulanciers paramédicaux et 8 policiers), recrutés à l’aide d’un échantillonnage raisonné et par boule de neige. Les entretiens ont été analysés à l’aide d’une analyse de contenu déductive. Le cadre TDF a guidé la conception de l’étude, le contenu des entretiens, la collecte et l’analyse des données.
Résultats
Les obstacles les plus signalés ont été des préoccupations concernant la confidentialité, le manque de confiance, le manque de connaissances des cliniciens sur la culture professionnelle, le manque de transparence quant à l’accès aux services et la stigmatisation au sein des organismes de premiers répondants. Les principaux thèmes influençant la recherche d’aide ont pu être classés au sein de 6 des 14 domaines du cadre TDF : le contexte environnemental et les ressources; les connaissances; les influences sociales; le rôle social/professionnel et l’identité; les émotions et enfin les croyances à l’égard des conséquences.
Conclusion
Nous avons pu cerner les principales mesures utilisables pour adapter les interventions afin d’encourager la participation à une clinique de traitement des blessures de stress opérationnel pour les premiers répondants : la transparence en matière de confidentialité, la présence de politiques visant à accroître les connaissances sur la culture professionnelle par l’ensemble du personnel de la clinique, des descriptions claires des modalités d’accès aux soins, la participation systématique des familles et la lutte contre la stigmatisation.
Optimal growth and development in early childhood is determined by a complex interplay of child, maternal, household, environmental, and socioeconomic factors that influence nutritional intake, but ...interventions to reduce child undernutrition sometimes target specific risk factors in isolation. In this analysis, we assess the relative importance of 13 correlates of child stunting selected based on a collective review of existing multi-factorial frameworks: complementary feeding, breastfeeding, feeding frequency, dietary diversity, maternal height, body mass index (BMI), education, age at marriage, child vaccination, access to improved drinking source and sanitation facilities, household indoor air quality, and household wealth. The analytic sample consisted of nationally representative cross-sectional surveys from the most recent Demographic and Health Surveys for Bangladesh (2014), India (2005), Nepal (2011), and Pakistan (2013), and from the National Nutrition Survey for Afghanistan (2013). In the mutually adjusted logistic regression model for 3,159 infants aged 6–8 months, short maternal stature (OR: 2.93; 95% CI: 1.93–4.46) and lack of complementary foods (OR: 1.47; 95% CI: 1.12–1.93) were associated with significantly higher risk of stunting. For 18,586 children aged 6–23 months, the strongest correlates of child stunting were: maternal height (OR: 3.37, 95% CI: 2.82–4.03), household wealth (OR: 2.25, 95% CI: 1.72–2.94), maternal BMI (OR: 1.59, 95% CI: 1.27–2.00), minimum dietary diversity (OR: 1.48, 95% CI: 1.27–1.72), maternal education (OR: 1.36, 95% CI: 1.18–1.56), and age at marriage (OR: 1.17, 95% CI: 1.05–1.30). Full vaccination and minimum dietary frequency were also found to be important for severe stunting for children of this age group. Some differences were found in the relative ordering and statistical significance of the correlates in country-specific analyses. Our findings indicate that comprehensive strategies incorporating a broader progress on socioeconomic conditions as well as investments in nutrition specific programs are needed to improve child undernutrition in South Asia.
•Risk factors for child undernutrition are often assessed in isolation.•We assessed the relative importance of 13 correlates of stunting in South Asia.•Socioeconomic conditions and child feeding practices were found to be most important.•The relative contribution of correlates for stunting differed by country and age group.•Interventions should comprehensively address multiple drivers of stunting in South Asia.
There are well-documented global increases in mean body mass index (BMI) and prevalence of overweight (BMI ≥ 25.0 kg/m(2)) and obese (BMI ≥ 30.0 kg/m(2)). Previous analyses, however, have failed to ...report whether this weight gain is shared equally across the population. We examined the change in BMI across all segments of the BMI distribution in a wide range of countries, and assessed whether the BMI distribution is changing between cross-sectional surveys conducted at different time points.
We used nationally representative surveys of women between 1991-2008, in 37 low- and middle-income countries from the Demographic Health Surveys (DHS n = 732,784). There were a total of 96 country-survey cycles, and the number of survey cycles per country varied between two (21/37) and five (1/37). Using multilevel regression models, between countries and within countries over survey cycles, the change in mean BMI was used to predict the standard deviation of BMI, the prevalence of underweight, overweight, and obese. Changes in median BMI were used to predict the 5th and 95th percentile of the BMI distribution. Quantile-quantile plots were used to examine the change in the BMI distribution between surveys conducted at different times within countries. At the population level, increasing mean BMI is related to increasing standard deviation of BMI, with the BMI at the 95th percentile rising at approximately 2.5 times the rate of the 5th percentile. Similarly, there is an approximately 60% excess increase in prevalence of overweight and 40% excess in obese, relative to the decline in prevalence of underweight. Quantile-quantile plots demonstrate a consistent pattern of unequal weight gain across percentiles of the BMI distribution as mean BMI increases, with increased weight gain at high percentiles of the BMI distribution and little change at low percentiles. Major limitations of these results are that repeated population surveys cannot examine weight gain within an individual over time, most of the countries only had data from two surveys and the study sample only contains women in low- and middle-income countries, potentially limiting generalizability of findings.
Mean changes in BMI, or in single parameters such as percent overweight, do not capture the divergence in the degree of weight gain occurring between BMI at low and high percentiles. Population weight gain is occurring disproportionately among groups with already high baseline BMI levels. Studies that characterize population change should examine patterns of change across the entire distribution and not just average trends or single parameters.
Despite the broad consensus that investments in nutrition-sensitive programmes are required to reduce child undernutrition, in practice empirical studies and interventions tend to focus on few ...nutrition-specific risk factors in isolation. The 2015–16 National Family Health Survey provides the first opportunity in more than a decade to conduct an up-to-date comprehensive evaluation of the relative importance of various maternal and child health and nutrition (MCHN) factors in respect to child anthropometric failures in India. The primary analysis included 140,444 children aged 6–59 months with complete data on 20 MCHN factors, and the secondary analysis included a subset of 25,603 children with additional paternal data. Outcome variables were stunting, underweight and wasting. We conducted logistic regression models to first evaluate each correlate separately in age- and sex-adjusted models, and then jointly in a mutually adjusted model. For all anthropometric failures, indicators of past and present socioeconomic conditions showed the most robust associations. The strongest correlates for stunting were short maternal stature (OR: 4.39; 95%CI: 4.00, 4.81), lack of maternal education (OR: 1.74; 95%CI: 1.60, 1.89), low maternal BMI (OR: 1.64; 95%CI: 1.54, 1.75), poor household wealth (OR: 1.25; 95%CI: 1.15, 1.35) and poor household air quality (OR: 1.22; 95%CI: 1.16, 1.29). Weaker associations were found for other correlates, including dietary diversity, vitamin A supplementation and breastfeeding initiation. Paternal factors were also important predictors of anthropometric failures, but to a lesser degree than maternal factors. The results remained consistent when stratified by children's age (6–23 vs 24–59 months) and sex (girls vs boys), and when low birth weight was additionally considered. Our findings indicate the limitation of nutrition-specific interventions. Breaking multi-generational poverty and improving environmental factors are promising investments to prevent anthropometric failures in early childhood.
•We evaluated a comprehensive set of correlates for child anthropometric failures.•Parental anthropometry, socioeconomic and environmental correlates were strongest.•Weaker and inconsistent associations were found for other correlates.•No systematic difference was found by children's age and sex.•Nutrition-sensitive programs should accompany nutrition-specific interventions.
There has been an increased focus on non-communicable diseases (NCDs) in India, especially on cardiovascular diseases and associated risk factors. In this essay, we scrutinize the prevailing ...narrative that cardiovascular risk factors (CVRF) and cardiovascular disease (CVD) are no longer confined to the economically advantaged groups but are an increasing burden among the poor in India. We conducted a comprehensive review of studies reporting the association between socioeconomic status (SES) and CVRF, CVD, and CVD-related mortality in India. With the exception of smoking and low fruit and vegetable intake, the studies clearly suggest that CVRF/CVD is more prevalent among high SES groups in India than among the low SES groups. Although CVD-related mortality rates appear to be higher among the lower SES groups, the proportion of deaths from CVD-related causes was found to be greatest among higher SES groups. The studies on SES and CVRF/CVD also reveal a substantial discrepancy between the data presented and the authors' interpretations and conclusions, along with an unsubstantiated claim that a reversal in the positive SES-CVRF/CVD association has occurred or is occurring in India. We conclude our essay by emphasizing the need to prioritize public health policies that are focused on the health concerns of the majority of the Indian population. Resource allocation in the context of efforts to make health care in India free and universal should reflect the proportional burden of disease on different population groups if it is not to entrench inequity.
Induction at 38-40 weeks of gestation has been broadly suggested for women with gestational diabetes mellitus (GDM), yet its benefits and risks remain unclear. This study aimed to systematically ...review and meta-analyze existing evidence on the effect of induction at term gestation among women with GDM.
We searched MEDLINE, EMBASE, Cochrane Libraries, and Web of Science from inception to June 2021. We included randomized controlled trials (RCTs) and observational studies comparing induction with expectant management among GDM term pregnancies. Primary outcomes included caesarean section (CS) and macrosomia. All screening and extraction were conducted independently and in duplicates. Meta-analyses with random-effects models were conducted to generate the pooled odds ratios (ORs) and 95% confidence intervals (CIs) using the Mantel-Haenszel method. Methodological quality was assessed independently by two reviewers using the Cochrane Risk of Bias Tool for RCTs and the Newcastle-Ottawa Scale for observational studies.
Of the 4,791 citations, 11 studies were included (3 RCTs and 8 observational studies). Compared to expectant management, GDM women with induction had a significantly lower odds for macrosomia (RCTs 0.49 0.30-0.81); observational studies 0.64 0.54-0.77), but not for CS (RCTs 0.95 0.64-1.43); observational studies 1.03 0.79-1.34). Induction was associated with a lower odds of severe perineal lacerations in observational studies (0.59 0.39-0.88). No significant difference was observed for other maternal or neonatal morbidities, or perinatal mortality between groups.
For GDM women, induction may reduce the risk of macrosomia and severe perineal lacerations compared to expectant management. Further rigorous studies with large sample sizes are warranted to better inform clinical implications.
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